There are many types of volunteers or donations. A type of donation that requires more involvement than other donations is organ donation. Living organ donations are one of the hardest decisions that humans can make because donating organ is not a simple and easy process. Even though, people know that organ donations could save a human's life, kidney donation is one of the organ donations that are still limited in the United States. The lack of kidney donations is leading to the death of people. Although a large portion of the articles debate the ethics of the legalization of financial compensation to living kidney donors, different types of financial compensations such as direct monetary compensation, improved healthcare and insurance, and tax benefits should be allowed for living kidney donors in order to increase the amount of the living kidney donations to save human's lives.

The amount of kidney failure has increased in the United States once the years. This means more people need to have kidney transplant surgeries. For example, in 2007, patients on the waiting list for kidney donations were 71,601, and in 2008, the number reached 76,089. Despite having only a year's difference between the studies, there was a huge increase of waiting list for kidney donations. These statistics show more kidney donations are needed in the United States. Unfortunately, the corresponding data reflects a reverse situation. Deceased kidney donation increased from 10,082 to 10,101 between 2007 and 2008. However, living kidney donations decreased from 6038 to 5966 between 2007 and 2008. Therefore, the total amount of kidney donations decreased from 16,120 to 16,067 (Wolfe 962). This comparison of data indicates that the number of people in need of kidneys and number overall kidney donations are reciprocally proportional. Even though there is an advanced enough medical technology to transplant organs safely from donors to recipients, the technology would be useless if there are not enough kidneys to do the transplants. Because of the lack of kidney donations for transplants, the alternative method has been dialysis.

Dialysis is one of the well-known kidney failure treatments, but it has a lot of negative effects on the patients. For example, Mr. Hil's daughter, who was only 10 years old, looked like she had serious flu symptoms, so she went to the emergency room. The result was that she had kidney failure, so she had to do dialysis immediately. It could save her life, but it made her worse at same time because dialysis causes obesity, anemia, low blood pressure, etc. The only benefit of dialysis would be the extension of a patient's life, but the patient begins difficult life from the point when they started dialysis. The usual schedule for a dialysis is about 3 hours for 3 days per week. Because of this, everyday life such as going school, work, or travel are almost impossible for the patients (Postrel 1).

However, kidney transplant surgeries, which are another method of kidney failure treatment, allow the patients to live like normal people with a little bit of taking medicine. They can go to school, work, and eat what they want. Unfortunately, there are not enough kidney donations that can make all people happy and healthy. Every year, about 4,000 people die while they are waiting for kidney donations. According to the University of California, San Francisco, their transplant center's patients on the waiting list need to wait about 21 years on average. Therefore, the patients get sicker and sicker while they are waiting for kidney donations from either deceased or living donors (Postel 1). 

Even if more people register to donate their kidneys after their death, the amount of kidneys is not enough to cover all people on the waiting list because the number of people on the waiting list is increasing every year. It means that more living kidney donations are needed in the United States in order to cover more patients' kidney transplants (Postel 1). Therefore, we need to find some ways that can increase the amount of living people who donate kidneys. 

Even though some people introduced financial compensation as a solution to increase living kidney donations, in most of the countries in the world, buying or selling kidneys and other organs is illegal. Despite there is a high possibility of increasing kidney donations by 5% if the government provides financial compensation to living kidney donors, there are many people who disagree with the legalization of financial compensation for a couple of reasons. For example, it could lead to the coercion of low-income people to donate their kidneys. If selling kidneys become legalized in the United States, some people argue that it would only target low-income or poor people since they need money to survive. Furthermore, it could have negative effects on donors. For example, even though poor people's kidneys are good enough to donate now, if they have some other health problems, then the rushed decision of kidney donation could affect their health negatively in the future. If financial compensation is allowed, then donors would not think of the risks of donation that could happen after transplant surgery (Allen et al 2031-2033). 

Despite of these worries of leading the coercion of living kidney donations, according to Dr. Halpern, who is a professor at the University of Pennsylvania, School of Medicine, people do not need to worry about whether the donors would not recognize the risk of donations because the money would not affect the awareness of the risk of surgeries. Also, financial compensation does not necessarily target low-income people since $10,000 of financial compensation would have the same influence on the low income-people and high-income people, which means a person who has less than $20,000 income and a person who has more than $100,000 income will be attracted to the $10,000 compensation equally ("Concerns" 1). 

Another reason for the rejection of financial compensation is altruism. In general, people think that organ donations should be done only when donors have altruistic intention on mind set when they donate organs. Altruism is the idea of self-sacrifice, so the ethicists claim that altruistic donations cannot be accompanied with remunerations, which is financial compensation in this case. If living kidney donors receive financial compensation, then donations could not be considered as altruistic because there is always the possibility that the recipients get worse after the transplants, if their bodies reject the transplanted organs. If that happens, only donors are getting the benefits because they already got paid for their donations (Moorlock 134). Altruism is connected to the "crowding out" problem. If financial compensation is allowed in the United States, then donors who are willing to donate without receiving money will decrease. It means that altruistic donors would not eventually donate their kidneys anymore (Allen et al 2031-2033).

Even though some people claim altruism is required for donating organs, according to the Nuffield Report, altruism is not required to donate someone's organs, including kidneys, because some people just donate their kidneys for self-interest by just helping others (Moorlock 138). Also, financial compensation would not decrease the altruistic donations, because if someone was willing to donate his or her kidney with both altruistic intentions and self-interest of helping others, and if they had to receive financial compensation but did not want it, he or she can simply donate the money to the kidney recipients. 

Besides the counterarguments of financial compensations to living kidney donors, one of the reasons that the amount of donations is low is because the donors become stakeholders after donating their living kidneys because they struggle financially. According to the United Network for Organ Sharing (UNOS), one fifth of the donors do not have appropriate health insurance to cover their aftercare of transplant surgeries. For those who have poor coverage, there is a lack of follow-up data from the transplant centers to the living kidney donors. This is more likely to happen to low-income donors. Also, many of African American donors were low-income donors. According to the UNOS, the follow-up system in clinics and laboratories in transplant centers has been improved year by year. However, the follow-up percentage is increasing by just about 1% each year, which is not a significant improvement to cover all living kidney donors (Schold et al 2394-2403). 

Since the follow-up care for living kidney donors is not enough to cover all donors, financial compensation could help them to get better aftercare. The donors will not have to hesitate about donating their kidneys if financial compensation such as better healthcare insurance becomes available. It will lead to the increase of living kidney donations because the donors would have less concern about financial problems after transplant donations. 

In most countries in the world, it is illegal to sell or buy organs because of similar reasons that the Unites States have. Even though laws in countries restrict transactions of organs, there is a black market, not just kidneys, but also for other organs. The black market is the illegal hidden market where organ transactions happen. A black market was created because people want to survive, but there are not enough kidneys to receive legally. Travel to the other countries to find organs and get transplants is called "health tourism." For example, some Americans make trips to other countries, such as Turkey, Russia, and South Africa, to find kidneys on the black market. (Major 67-69).  

Black market is illegal, but most of countries could not get rid of this illegal market. However, Iran did not ignore the problems of the black market. They faced the problems of black markets, and they decided to legalize financial compensation to living kidney donors and living organ donors to increase the amount of donations in their country so that they can protect their citizens from illegal transactions. They started to compensate living kidney donors by supporting transplant funding and have been compensating donors since 1988. Surprisingly, the amount of transplant surgeries has doubled a year after the legalization of financial compensation, and four-fifths of which the transplant donations were from living organ donations, including living kidneys. Furthermore, they also provided free health insurance to donors. According to the Hashemi Nejad Hospital (HNH) in Iran, they did 2,000 transplant surgeries in 2006, three quarters of which were living organs. Since the donations increased, more people on the waiting list could have transplants, which means the legalization of financial compensation had positive effects because it can save more people's lives (Major 67-69). 

Based off of the case of Iran's financial compensation to living kidney donors, the financial compensation system for living kidney donors has a lot of benefits, including increasing donation amounts, but it is still illegal in the United States. Then what could solve the lack of kidney donations in the United States? The best ways to approach this problem is to find different types of financial compensation to fit each donor's preference.

The basic financial compensation to kidney donors would be direct monetary compensation. However, there could be many other types of financial compensation. For example, instead of a direct monetary financial compensation, the U.S. government could provide free or better healthcare insurance. This might be able to protect poor people from rich people if rich people try to buy poor people's kidneys by offering a huge amount of money (Major 67-69). Since the United States now have the Obama healthcare system, people already have healthcare insurance. However, this insurance is not enough to cover donors with low-income because they pay less for Obama healthcare insurance, so they get less insurance benefits. However, if the government provides better healthcare insurance to those who donate their kidneys, both donors and the government get benefits because donors can get better health care for the rest of their lives, and the government can gain living kidney donations. 

The limited healthcare to living kidney donors after donating causes financial disincentives. Even though the living kidney donors should not have any disincentives as a result of donating their kidneys, many donors suffer from negative financial outcomes after donating. To decrease disincentives, another method of financial compensation could be a tax benefit. Unfortunately, since some donors need more healthcare after donating their living kidneys, the donors need to go to the hospitals more often for their aftercare. As a result, many living kidney donors end up losing money after their donations, which is unfair because they are saving human lives but get disincentives for saving human lives. The decrease of disincentives of donors by proving tax benefits to donors would decrease their financial pressure, so it would increase the number of living kidney donations (Rettner 1). 

Increasing the number of donations via financial compensations not only benefits the kidney failure recipients but also the government. The U.S. government is already funding kidney failure patients' dialysis, and it costs around $65,000 to $75,000 per year for each patient (Retter 1). Furthermore, according to the National Kidney and Urologic Diseases Information Clearinghouse, the total amount of the funding for dialysis of kidney failure was $40 billion in 2009 (Bushak, 1). However, if the government provided financial compensation of $10,000 per donor, which is significantly less than one patient's annual dialysis funding, then the government could save money from dialysis funding (Retter 1). For example, if the amount of the kidney donations increased by ten to twenty percent, then the government could save between $1,600 and $4,000 of funding for each kidney failure patient (Bushak, 1). 

Even though the government legalizes financial compensation for living kidney donors, if people do not know how the organ donation system works, they will not be able to donate. In order for financial compensation for living kidney donors to be effective in increasing the number of living kidney donors, donors need to be informed about the organ donation system. Here are the steps for how the organ donating steps work. First, if a patient is a good candidate to be a transplant recipient, then they can be put on the National Transplant Waiting List. Then, the National System finds the donors that match with patients based off of blood types, body size, distance from donors, level of sickness of patients, tissue types, and the length of time that patients have waited for a transplant. Usually, deceased organ donations happen when injured patients fail to live after surgery. Their families can decide whether they are going to donate the deceased patients' organs or not. If their families agree to donate the deceased patients' organs, then the National System uses a waiting list to find matching kidney failure patients. Otherwise, living organ donors can sign up through the office of motor vehicles (DMV) or though organdonor.gov ("Donations" 0:00-4:57). 

There are many opposing views regarding financial compensation of living kidney donors. These include altruism, the possibility that the law regarding financial compensation might only target low-income people, possibility of making coercive decisions, and becoming unaware of the risks of donating. Despite these counterarguments, the U.S. government should provide different types of financial compensations such as direct monetary compensation, tax benefits, and better health cares and insurances for donors to increase the number of kidney donations. Including increase of the number of living kidney donations, financial compensations could benefit all 3 components: the donors will worry less about financial problem from donating their living kidneys, which will increase the amount of living kidney donations; the increase of kidney donations will save more kidney failure patients by transplant surgeries; the government will get benefit because compensating donors costs less than dialysis funding. Therefore, financial compensation for living kidney donors should be legalized in the United States because it can save more patients on the waiting list. 

